Anemia is common in patients presenting for elective surgery and is predictive of poor postoperative outcomes after surgery as well as increased resource utilization. Previously undiagnosed anemia has been reported to occur in 5% to 75% of elective presurgical patients, depending on the patient population.1 In addition to being an independent risk factor for perioperative morbidity and mortality,2,3 preoperative anemia is one of the strongest predictors of perioperative blood transfusion.4,5 Perioperative blood transfusion in turn is independently associated with an increased risk of perioperative morbidity, including lung injury, renal failure, hemolysis, and transfusion reaction, as well as mortality.6,7 Besides its direct contribution to worsened outcomes, blood transfusion imposes a significant financial burden on health institutions. In addition to the immediate material and labor costs, there are longer-term costs associated with blood transfusion including prolonged ventilator dependence, increased intensive care unit and hospital length of stay, and postoperative loss of productivity, which together significantly increase the health resource burden.8 Accordingly, reducing unnecessary blood product transfusion has been shown to reduce health care costs.9 Among the nearly 21 million blood components transfused per year in the United States, approximately half were transfused in the perioperative setting (National Blood Collection and Utilization Survey Report, 2011). Costs associated with transfusion are estimated at $522 to $1183 per unit of red blood cells (RBCs) administered, with estimates of perioperative cost of transfusion ranging from $1.6M to $6M per hospital per year.8